Five year review of treatment outcome of directly observed therapy (DOT) for re-treatment pulmonary tuberculosis patients in UCH, Ibadan, Nigeria

Tuberculosis (TB) is a major health problem in Nigeria. The country is currently fourth among the 22 high-burden countries (HBCs) of the world; with an incident of all new cases of 311/100;000 population per year out of which 137/100;000 population are smear positive and prevalence of 616/100;000 population. To highlight the burden of re-treatment smear positive pulmonary TB with and without HIV infection and determine how Directly Observed Therapy (DOT) using the retreatment regimen has affected the treatment outcome in the management of these patients. A Fiveyear retrospective study from April 2003 to March 2008 to evaluate the treatment outcome data of retreatment pulmonary TB who were also screened and confirmed for HIV at the outpatient clinic of the University College Hospital Ibadan; Nigeria. The effect of HIV status and treatment outcome was assessed so also the prevalence of HIV among recurrent PTB patients. The total number of cases assessed was 127. Majority of the patients were between the ages of 20 to 49(73.2). Forty-two of the PTB patients were HIV positive (33.1). The treatment outcome was as follows: Cured 81(63.8); Treatment completed 13(10.2); Died 22(17.3); Defaulted four (3.1) and transferred out seven (5.5) More patients were cured and had treatment completion among the HIV negative patients compared with HIV positive patients (p0.0001) The mortality was higher in those with HIV positive than negative patients (p 0.0001). Re-treatment pulmonary TB is frequent at this referral centre. A contribution to re-treatment prevention entails more rigorous management of new TB cases; particularly at lower levels of care. This effort will reduce the emergence of multi-drug resistant (MDR-TB) tuberculosis

The Challenge of Re-Treatment Pulmonary Tuberculosis at two Teaching and Referral Hospitals in Uganda

Background With an annual tuberculosis (TB) incidence of about 350 cases per 100;000 of the population; Uganda is a high burden country. Moreover; it is evident that some TB patients have been treated for a previous episode of the disease. Objective To highlight the burden of re-treatment pulmonary TB and examine patient factors associated with re-treatment among adults at two teaching and referral hospitals; Mbarara and Mulago Methods A descriptive cross sectional study with data collection between September 2004 and March 2005; we calculated the prevalence and used logistic regression to explore factors associated with re-treatment. Results The prevalence of re-treatment pulmo-naryTB at Mbarara based on medical records was 30.0(95CI: 21.2 to 40.0); and 21.3(95CI: 12.9 to 31.8) from exit interviews.The corresponding estimates at Mulago hospital were 12.0(95CI: 6.4 to 20.0) and 43.9(33.0 to 55.3). Compared to the 18-26 year age category; the prevalence odds ratio (POR) for a seven-year increase in age was 1.54 (95CI: 1.04-2.28; p = 0.027); while female patients were 0.39 (95CI: 0.17-0.90; p = 0.025) times less likely to report re-treatment disease than males; in this facility-based study. Conclusions Re-treatment pulmonary TB is frequent at the two teaching and referral hospitals.A contribution to re-treatment prevention should entail more rigorous management of new TB cases; particularly at lower levels of care